A recent roundtable discussion highlighted the growing number of treatment options for pancreatic neuroendocrine tumors (pNETs), with therapy choices depending on whether the goal is disease control or tumor shrinkage. Targeted therapies such as everolimus and sunitinib are mainly used to stabilize disease. In the RADIANT-3 trial, everolimus improved progression-free survival to 11 months compared with 4.6 months for placebo, although tumor shrinkage rates remained low.
For patients with larger or symptomatic tumors, the CAPTEM regimen of capecitabine and temozolomide remains a preferred option. The combination achieved a 40% response rate and progression-free survival of 23 months, outperforming temozolomide alone.
Cabozantinib has also shown promise as a later-line therapy, producing tumor shrinkage in 19% of heavily pretreated patients. Experts said treatment sequencing should be individualized, with PRRT often used earlier because of its balance between effectiveness and tolerability.